Abstract 2279: Ethnic Comparisons in Pre-Stroke Awareness and Treatment of Hypertension in Stroke Subjects: Modification by SES and Acculturation
Background and Objectives: Mexican Americans (MAs) have higher stroke incidence rates than non-Hispanic whites (NHWs). Ethnic differences in the pre-stroke treatment of risk factors could potentially explain this disparity and may be exacerbated by low socio-economic status or less acculturation. We assessed pre-stroke awareness and treatment of hypertension by ethnicity, education and English proficiency in a population-based stroke surveillance project.
Methods: Among 1,111 stroke subjects aged ≥45 years in the Brain Attack Surveillance in Corpus Christi (BASIC) project from 01/2000-06/2006, we examined pre-stroke hypertension prevalence (medical record documentation of hypertension diagnosis) at the time of the index stroke by ethnicity (MA vs. NHW). Among those with prevalent hypertension, we measured awareness (self-report of hypertension) and treatment (self-report of anti-hypertensive medication use). We first compared awareness and treatment of hypertension by ethnicity overall. We then compared ethnic differences in awareness and treatment of hypertension using 2 approaches: 1) after stratification by education (<high school vs. ≥high school); and 2) after dichotomizing MAs by self-reported language fluency. Limited English proficiency (EP) was defined as Spanish only (less accultured) and EP was defined as English only/bilingual (more accultured).We adjusted associations for age, gender, education, diabetes, coronary artery disease, and previous stroke using logistic regression.
Results: MAs (mean age 68.3 ± 12.1 years; n=566) were more likely than NHWs (mean age 74.4 ± 11.7 years; n=545) to report <high school education (71% vs. 23%; P<0.001). Thirty-two percent of MAs reported limited EP. Hypertension prevalence was 74% in both MAs and NHWs. There was a trend toward MAs having greater awareness than NHWs (89% vs. 85%; P=0.15) but similar treatment (89-90%) of hypertension. Among high school graduates, we found non-significant trends toward greater awareness but less treatment of hypertension in MAs compared with NHWs (Figure 1). Compared with MAs with EP, NHWs and MAs with limited EP had less awareness of hypertension but similar treatment (Figure 2). After adjustment for socio-demographics and co-morbidities, differences in hypertension awareness were no longer significant (NHWs: aOR, 0.96; 95%CI, 0.52-1.79; MAs with limited EP: aOR, 0.57; 95%CI, 0.27-1.19; MAs with EP: referent).
Conclusion: We found little evidence that differences in pre-stroke awareness and treatment of hypertension may explain ethnic disparities in stroke.
- © 2012 by American Heart Association, Inc.